Steffen Marquardt

Evaluation of the use of a tablet computer with a high-resolution display for interpreting emergency CT scans.

PURPOSE Evaluation of the potential usability of an iPad 3 with a high-resolution display in CT emergency diagnosis compared to a 3 D PACS workstation. MATERIALS AND METHODS 3 readers used a 5-point Likert scale to evaluate 40 CCT scans and 40 CTPA scans to determine the detectability of early signs of infarction in CCT or segmental and subsegmental pulmonary embolisms in CT angiography of the pulmonary arteries (CTPA) on the iPad 3 (Apple Inc., USA) using an application for image viewing (Visage Ease, Visage Imaging GmbH, Berlin) and on a 3 D PACS workstation (Visage 7.1, Visage Imaging, Berlin) using a certified monitor for image viewing. The results were compared using the Wilcoxon rank sum test, Spearmans correlation coefficient, and a kappa statistic. RESULTS There was no significant difference in the median evaluations for the readings of both the CCT scans and the CTPA scans on the iPad 3 and on the workstation (p > 0.05) for all three readers. The mean Spearmans correlation coefficient for CCT and CTPA was 0.46 (± 0.2) and 0.69 (± 0.16), respectively, for the comparison iPad/PACS, 0.41 (± 0.16) and 0.68 (± 0.06), respectively, for the interobserver agreement on the iPad, and 0.35 (± 0.05) and 0.68 (± 0.10), respectively, for the interobserver agreement on the PACS. Mean kappa values for CCT of 0.52 (± 0.17) for the comparison iPad/PACS and 0.33 (± 0.16) and 0.32 (± 0.16), respectively, for the interobserver agreement on the iPad and the PACS were achieved. For CTPA average kappa values of 0.67 (± 0.19) were calculated for the comparison iPad/PACS and 0.69 (± 0.08) and 0.60 (± 0.14), respectively, for the interobserver concordance on the iPad 3 and the PACS. All differences were not statistically significant (p > 0.05). CONCLUSION The variability of the interpretation of typical emergency scans on an iPad 3 with a high-resolution display and on a 3 D PACS workstation does not differ from the interobserver variability.

Transarterial chemoembolization (TACE) for colorectal liver metastases—current status and critical review

BackgroundTransarterial liver-directed therapies are currently not recommended as a standard treatment for colorectal liver metastases. Transarterial chemoembolization (TACE), however, is increasingly used for patients with liver-dominant colorectal metastases after failure of surgery or systemic chemotherapy. The limited available data potentially reveals TACE as a valuable option for pre- and post-operative downsizing, minimizing time-to-surgery, and prolongation of overall survival after surgery in patients with colorectal liver only metastases.PurposeIn this overview, the current status of TACE for the treatment of liver-dominant colorectal liver metastases is presented. Critical comments on its rationale, technical success, complications, toxicity, and side effects as well as oncologic outcomes are discussed. The role of TACE as a valuable adjunct to surgery is addressed regarding pre- and post-operative downsizing, conversion to resectability as well as improvement of the recurrence rate after potentially curative liver resection. Additionally, the concept of TACE for liver-dominant metastatic disease with a focus on new embolization technologies is outlined.ConclusionsThere is encouraging data with regard to technical success, safety, and oncologic efficacy of TACE for colorectal liver metastases. The majority of studies are non-randomized single-center series mostly after failure of systemic therapies in the 2nd line and beyond. Emerging techniques including embolization with calibrated microspheres, with or without additional cytotoxic drugs, degradable starch microspheres, and technical innovations, e.g., cone-beam computed tomography (CT) allow a new highly standardized TACE procedure. The real efficacy of TACE for colorectal liver metastases in a neoadjuvant, adjuvant, and palliative setting has now to be evaluated in prospective randomized controlled trials.

Surgical treatment of coronary artery aneurysms

Coronary artery aneurysms (CAA) are rare. We present our experience with the surgical treatment of patients with CAAs.

Erratum to: Comparison of Technical and Clinical Outcome of Transjugular Portosystemic Shunt Placement Between a Bare Metal Stent and a PTFE-Stentgraft Device.

Purpose To analyse technical and clinical success of transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension and compare a stent and a stentgraft with regard to clinical and technical outcome and associated costs.

Quality of life in patients undergoing repetitive TACE for the treatment of intermediate stage HCC

PurposeWith a limited overall survival (OS) of 20 months in patients diagnosed with intermediate stage hepatocellular carcinoma (HCC), the preservation of quality of life (QoL) during transarterial chemoembolization (TACE) procedures remains a primary goal. The aim of our study was to evaluate the change in QoL amongst patients undergoing repetitive TACE and to identify specific risk factors that may predict change in QoL.MethodsQoL was assessed in 82 patients undergoing at least two TACE, before and 14 days after TACE, using validated EORTC QLQ-C30 and EORTC HCC18 questionnaires. Tumour response was assessed using established response criteria. Laboratory and clinical parameters were analysed.ResultsFunctional scores decreased due to first TACE treatment (p < 0.01), conversely symptom scores increased significantly (p < 0.01). During repetitive TACE no statistically significant changes were observed. Higher Global Health- and Physical Functioning scores at baseline were identified as independent prognostic factors for greater decrease in QoL. Tumour response did not alter QoL at all. Furthermore higher symptom scales including pain (p = 0.00), nausea and vomiting (p = 0.00) and fever (p < 0.01 for repetitive TACE) at baseline were predictive of a significantly lesser increase of symptom severity, and a greater reduction in pain during a course of TACE. Higher C-reactive protein (CRP) at baseline and female gender were associated with a greater decrease of functional scales and increase of symptom scales.ConclusionQoL amongst patients receiving repetitive TACE showed neither significant nor clinically relevant changes over time. Pre-treatment assessment of QoL-scores, clinical and laboratory parameters can improve patient selection for TACE whilst optimizing QoL.

Percutaneous hepatic perfusion (chemosaturation) with melphalan in patients with intrahepatic cholangiocarcinoma: European multicentre study on safety, short-term effects and survival

ObjectivesCholangiocarcinoma is the second most common primary liver tumour with a poor overall prognosis. Percutaneous hepatic perfusion (PHP) is a directed therapy for primary and secondary liver malignancies, and its efficacy and safety have been shown in different entities. The purpose of this study was to prove the safety and efficacy of PHP in patients with unresectable intrahepatic cholangiocarcinoma (iCCA).Patients and methodsWe retrospectively reviewed data from 15 patients with unresectable iCCA treated with PHP in nine different hospitals throughout Europe. Overall response rates (ORR) were assessed according to response evaluation criteria in solid tumours (RECIST1.1). Overall survival (OS), progression-free survival (PFS) and hepatic PFS (hPFS) were analysed using the Kaplan-Meier estimation. Adverse events (AEs) and toxicity were evaluated.ResultsFifteen patients were treated with 26 PHPs. ORR was 20%, disease control was achieved in 53% after the first PHP. Median OS was 26.9 months from initial diagnosis and 7.6 months from first PHP. Median PFS and hPFS were 122 and 131 days, respectively. Patients with liver-only disease had a significantly longer median OS compared to patients with locoregional lymph node metastases (12.9 vs. 4.8 months, respectively; p < 0.01). Haematological toxicity was common, but manageable. No AEs of grade 3 or 4 occurred during the procedures.DiscussionPHP is a standardised and safe procedure that provides promising response rates and survival data in patients with iCCA, especially in non-metastatic disease.Key Points• Percutaneous hepatic perfusion (PHP) offers an additional locoregional therapy strategy for the treatment of unresectable primary or secondary intrahepatic malignancies.• PHP is a standardised and safe procedure that provides promising response rates and survival data in patients with intrahepatic cholangiocarcinoma (iCCA), especially in non-metastatic disease.• Side effects seem to be tolerable and comparable to other systemic or local treatment strategies.

Coil embolization of reversed-curve hepatointestinal collaterals in radioembolization: potential solutions for a challenging task

Depending on the planned catheter position for selective internal radioembolization, coil embolization of hepatic artery branches can be necessary to enable a selective and safe procedure. The anatomy of the hepatic arterial bed has been demonstrated to have a substantial number of anatomic variations, which turns coil embolization into a challenge if the feeder shows a reversed, “hairpin-like” turn immediately after its origin. Hepatointestinal collateral vessels originating from the periphery of the right hepatic artery often present with such a reversed course and can preclude patients from uncomplicated radioembolization if catheterization fails. The purpose of this report is to describe 2 potential solutions for successful coil embolization of reversed-curve hepatointestinal collateral vessels using either a regular 4 French RIM catheter or a novel steerable tip-deflecting microcatheter.

A Close Call: An Impacted Knife Injury to the Thorax

A 21-year-old woman with a history of psychiatric treatment was admitted to the emergency department with self-inflicted stab wounds to the neck, chest, and abdomen as the result of a suicide attempt. Inspection showed a seemingly superficial cut at the jugular fossa. The patients mother stated that one long ceramic kitchen bread knife was totally embedded in the right thorax. Further diagnostic measures showed the missing kitchen bread knife penetrating the right chest, with the path of insertion starting 2 cm above the right clavicle and the blade in contact with the right hilum and ending next to the seventh thoracic vertebra. Retrieval the object was a challenging problem.

Chronisch thromboembolische pulmonale Hypertonie: Diagnostischer Zugewinn durch C-Arm CT im Vergleich zur digitalen Subtraktionsangiografie

Material und Methodik: Retrospektive Analyse von 143 konsekutiven Patienten mit dem klinischen Verdacht einer Lungenarterienembolie untersucht in 3 verschiedenen Computertomographen in der klinischen Routine. Das Bolus tracking erfolgte mit 120 Hounsfield-Einheiten (HU) Grenzwert und Region of interest (ROI) im Truncus pulmonalis (Gruppe A, n=70) bzw. zur Verzögerung des Untersuchungsbeginns in der Aorta descendens (Gruppe B, n=73). Die Kontrastmitttelmenge betrug 70 bis 120 ml Iomeprol 300. Mit dem t-Test wurde die erreichte Dichte im Truncus pulmonalis verglichen. Weiterhin erfolgte eine Regressionsanalyse möglicher Begleitfaktoren.